Healthcare Provider Details

I. General information

NPI: 1487964961
Provider Name (Legal Business Name): DANIEL W. BJORGE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANDSTUHL REGIONAL MEDICAL CENTER UNIT 33100
APO AE
09180
US

IV. Provider business mailing address

USA DENTAC JAPAN UNIT 45011
APO AP
96343-5011
US

V. Phone/Fax

Practice location:
  • Phone: 314-636-9559
  • Fax:
Mailing address:
  • Phone: 315-263-8189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0401413474
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6593-015
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401413474
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: